Of all the aches and pains that athletes can get, this one's probably the least age-related. And the treatment, which is not complicated or extensive, is the same for everybody from kids to grandparents.

It all starts with the kneecap
In a perfect world, it rides up and down in the V-shaped groove just behind it as you walk, run, or cycle. More typically, though, your foot rolls in, or pronates, as you move from heel-strike to toe-off, and the kneecap ends up scraping along one side of the groove instead of sliding smoothly up and down the middle. The cartilage there doesn't much like getting sort of sandpapered down that way, nor does the back of the kneecap, which begins to weep fluid that in turn produces a feeling of stiffness. And though runners have named the condition, it crops up often among cyclists, not to mention in cleated-shoe sports like soccer and baseball whose footwear can put sideways torque on the knee.

You can diagnose it from the other side of the room: joint hurts, no particular injury caused it, worst going upstairs and downstairs, stiffens after sitting awhile, like it needs to be stretched. That settles it.

Despite what you may have read, arthroscopic surgery helps perhaps one out of 100 sufferers. Mechanically smoothing the rubbing surface of the kneecap can last for six months or so, but unless your biomechanics have changed, it's a borrowed-time fix. Cutting the retinaculum, the connective tissue holding the kneecap in place to loosen it in the groove, is also only temporary. It eventually scars down tighter than it was before. Sooner or later, you're back where you started.

Orthotics
Proper orthotics are the single most important step, since they prevent the roll that caused the scraping in the first place. The good news is once you start wearing them, your knee cooperates quickly: The patella cartilage that's been rubbed down is able to regenerate and heal itself.

But orthotics alone won't do it. You need your other ally, the medial quad, the muscle in the front of your thigh that's supposed to hold the kneecap in the center of the groove. The stronger it is, the better it can do its job. But there's a rub: Leg extensions usually used to strengthen the quads also pull the kneecap back down into the groove and grind it up some more. No good. But the terminal extension exercises (in the box), which limit the motion to the last six inches of extension, don't. Do them daily until the pain disappears, then twice weekly. Both legs, please. They're a matched pair, and what's already happened on one side is a good bet for the other some day.

Time for a Quad Job 1. Sit up on a desk or high surface, stick your leg out straight, drop it about 6" and support it with a chair or stool. 2. Fill a gym bag or duffel with weights, books, soup cans, whatever, and strap it to the lower leg. 3. Lift only the last 6" (about 30 degrees) to full extension, hold for three seconds, then come slowly back down. Do 5 sets of 10 reps each day, with just enough weight that you get to 5 or 6 on that fifth set, and have to stop. Can't get there? Take out some weight. Can do all 10? Add some weight.

Knee sleeves and bandages are out. Think about it. If you compress the kneecap, every motion will press it into the groove. Keep it loose and free. Are you cured? No. You could have your orthotics super-glued to your feet for a year, and if you took them off, after a year and one minute your inherited biomechanics would resume, and eventually the pain right along with it. So make these exercises part of your weekly routine.

Dr. Maharam is a NYC sports medicine specialist, he is also the medical director of The N.Y. Road Runner's Club, The NYC Marathon and the secretary/ treasurer of the International Marathon Medical Directors Association.

American Cancer Society American Dental Association American Diabetes Association American Dietetic Association American Heart Association The Physician and Sport Medicine Healthfinder.gov Healthweb.org Medlineplus.gov WebMD.com Newsweek.msnbc.com Health

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